| NPI | 1235784190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136791) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2026-08-03 |